Sometimes you just have to let someone else do it! The Art of Delegation Sometimes you just have to let someone else do it!

Before you delegate, Know: If your state allows LPN/LVN to delegate (not all states do) If your state allows LPN’s to delegate, then you will have the authority to delegate duties to nursing assistants. If you board of nursing allows you to delegate, you must also have permission from you place of employment and it must be contained in their written policies.

What is the difference between: Assignment: these are tasks (activities) that are carried out by nursing assistants. Nursing assistants learn how to perform a task. Delegation: refers to duties that LPN’s perform after successfully passing the NCLEX-PN. The duties are your scope of practice you have learned why a duty is performed and what could go wrong during the performance of a duty.

The LPN’s role in Assigning Distribute the workload-this occurs at the beginning of the shift and is a common LPN task. When you assign your nursing assistants tasks, you are assigning them duties to complete for which they have been hired,paid and trained to perform. The tasks are in their job descriptions The nursing assistant is responsible for completing these tasks in a timely and safe manner. The LPN must monitor the progress of their UAP

The LPN’s role in Assigning Because assignments involve allocating the tasks that are to be done by nursing assistants within their job description, these team members cannot refuse the assignment. An exceptions would be if the UAP decides they are unqualified to perform the task. UAP assume responsibility and accountability for completing assigned tasks safely and in a timely manner.

The LPN’s role in Delegating You are transferring the authority to perform duties that are in the job description of an LPN to a UAP. These duties are in your scope of practice You do not have to delegate if you do not want to.

The LPN’s role in Delegating When delegating, you decide to ask UAP to do part of your job as an LPN It involves the ability to share power with UAP It is not asking UAP’s to complete jobs that the LPN dislikes! You are asking an UAP to perform some of your job description in order to improve resident care and meet all residents needs

The LPN’s role in Delegating UAP must give approval to the Delegated task UAP must voluntarily accept Delegated task They cannot be forced to accept a delegated task When delegating the LPN must provide the necessary information, assistance, and equipment to safely carry out the delegated duty.

Learning to effectively delegate can: Increase your effectiveness and efficiency as an LPN/LVN charge nurse Can be instrumental in realizing patients goals(outcomes) in a cost effective manner. May help UAP’s to increase and improve their job skills.

In long term care areas: RN is generally in the building during day/evenings, during night shift is available by phone. RN delegates the duty of charge nurse to LPN. RN is ultimately responsible along with the LPN who was delegated the task of charge nurse, the LPN and RN share accountability for their actions and those actions of their UAP’s

What to delegate? Never delegate what is in your legal scope of practice as an LPN Legal scope of practice is what you are able to do because you are an LPN. Remember your license is at stake in the matter of delegating nursing duties

Suggestions for legal soundness when delegating Delegate only if allowed by your states Nurse Practice Act and facility policies Delegate duties for which nursing assistants have demonstrated ability Provide specific, objective, clear cut directions to UAP on delegated tasks Provide assistance and instructions to UAP’s when you delegate a task Monitor their progress Intervene if correction is needed to maintain safety Upon completion, evaluate the safety and effectiveness of duties delegated If you delegated improperly and a resident is harmed you are liable If you delegated properly and a resident is harmed the UAP is liable.

The Nursing Process Collecting Data: The report that you receive at the beginning of your shift will be your basis for collecting data on resident needs. This is legally necessary so that you can safely distribute the work of the shift to UAP’s. Report may be taped or verbal.

The Nursing Process Planning: involves deciding outcomes for the shift, setting priorities of care, and then using specific directions and assigning/delegating the appropriate task. Identify Resident Goals/Outcomes. Goals are desired results in patient progress after nursing interventions. What is the goal for each resident for the shift?

The Nursing Process Set Priorities: Priority number one: life threatening situations, real or potential Resident with chest pain. What is goal? Resident who is dying. What is goal? Resident with adverse reaction to medication. What is goal? Resident who is attempting to flee. What is goal?

The Nursing Process Priority number two: Essential for safety: Which residents, because of weight require two people assist with transfers Which residents because of poor balance require assistance with ambulation Essential to nursing plan of care: ordered treatments, listed nursing interventions, administering drugs, vital signs, turning, ambulating and feeding.

What do I delegate? Ask yourself what is the intended outcome of this nursing duty? Resident is recuperating from total hip replacement, residents bath time is being used to teach family members how to observe for signs of skin breakdown – then licensed nurse needs to be present. Feeding aphasic stroke patient?

Examples of duties not to delegate Complex sterile dressing changes: UAP’s do not have training in sterile technique. Crisis situations (you the nurse needs to be there): examples: sudden acute SOB, chest pain, etc. Patient education: RN does initial, LPN reinforces the education and documents UAP’s can collect simple data, but they may not make decisions based on their collected data, ex: BGM, BP, P, medications etc. Duties that are part of your legal scope of practice may never be delegated

Deciding to delegate Right person: a competent UAP should be able to perform the following tasks: Communicate effectively Collect basic subjective and objective data Perform noncomplex nursing activities safely and accurately, and according to standard procedure, And seek guidance and direction when appropriate

Deciding to delegate Review your facilities job descriptions, legally you must know your UAP’s job description. Know the level of competence of your UAP Are they certified How much training have they had What skills have they been taught Does the facility update yearly skills checklist What clinical strengths/weakness have you observed Have they demonstrated previous competency to you? Have they completed orientation at your facility What activities have they stated they feel comfortable with and which have they told you they are not? Ask if they have performed the procedure before Ask what they would do in certain scenario’s

Deciding to delegate Right circumstance: setting and patient situation must be considered when delegating. Would not occur if: Resident is unstable Unit does not have the correct equipment or supplies to carry out the procedure safely Safety issues for the UAP, including infection control issues Staffing levels are so limited that you cannot monitor or assist when needed to ensure patient safety

Deciding to delegate Communication: Give objective detailed, clear cut direction Consider writing assignments in a concise master assignment sheet Explain what is expected at the UAP’s level of understanding Be specific about the results that you wish to see Provide guidelines for reporting after the delegated duty is completed Make sure your directions are specific and complete UAP’s can complete BGM but they cannot make decisions about insulin!

Deciding to delegate Your UAP has the right to refuse a delegated duty. Your UAP cannot refuse an assigned task As the nurse, you must evaluate that the delegated task and assigned duties where indeed completed correctly.